Report (OEI-02-13-00170)

Complete Report

Summary

WHY WE DID THIS STUDY

This memorandum report presents performance data for the Senior Medicare Patrol (SMP) projects. OIG has collected these data since 1997. In July 2010, the Administration on Aging (AoA), which is now part of ACL, requested that OIG continue to collect and report performance data for the projects to support its efforts to evaluate and improve their performance. OIG currently reports this performance data on an annual basis.

HOW WE DID THIS STUDY

This review is based on data reported by the SMP projects. In addition, we requested and reviewed documentation from the projects for the funds recovered for Medicare, Medicaid, beneficiaries, and others that were attributable to the projects. We also requested and reviewed documentation for the measure of cost avoidance. We did not review documentation for the other performance measures.

WHAT WE FOUND

The SMP projects recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of health care fraud. In 2012, the 54 projects had 5,137 active volunteers, a 9-percent decrease from 2011. These volunteers conducted 113,457 one-on-one counseling sessions and 14,748 group education sessions, a 71-percent and 33-percent increase from 2011, respectively.

In 2012, expected Medicare and Medicaid funds recovered that were attributable to the projects were $6 million. In addition, total savings to beneficiaries and others increased from $13,657 in 2011 to $133,977 in 2012. However, there was more than a 50-percent decrease in cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others; the total for 2012 was $113,692. Finally, one project provided information to Federal prosecutors for a case that eventually resulted in a $12.9 million settlement.

We continue to emphasize that it is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and abuse from the projects. Therefore, the projects may not be receiving full credit for savings attributable to their work. In addition, the projects are unable to track the substantial savings derived from a sentinel effect whereby fraud and errors are reduced by Medicare beneficiaries' scrutiny of their bills.